These effects remained transient, and disease escape was associated with the re-emergence of the dominant subclones. Genotyping of single CD34 +CD38 − cell–derived colonies showed that the decrease in the size of dominant subclones could be associated with the rise of founding clones or of hematopoietic stem cells devoid of recurrent mutations. The decrease in the variant allele frequency of major mutations was more significant in responders than in nonresponders ( P <. Analysis of variant allele frequencies indicated a decrease of major mutations in 15 of 20 responders compared with 10 of 22 nonresponders after 4 cycles. The fate of clonal architecture of single CD34 +CD38 − hematopoietic stem cells was also determined in 5 cases. Clonal evolution was analyzed after 4 cycles of treatment in 42 cases and reanalyzed at later time points in 18 cases.
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We investigated recurrent mutations by next-generation sequencing in 94 non-del(5q) MDS patients randomized in the GFM-Len-Epo-08 clinical trial to lenalidomide or lenalidomide plus epoetin β. The impact of recurrent somatic mutations identified in the diseased clone in response to lenalidomide and the drug’s effects on clonal evolution remain unknown.
Addition of an erythropoiesis-stimulating agent could improve response rate. Non-del(5q) transfusion-dependent low/intermediate-1 myelodysplastic syndrome (MDS) patients achieve an erythroid response with lenalidomide in 25% of cases.
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